Lymphoma - patho, dx, staging and tx

• Clonal expansion
• arrest of dxn
• loss of apoptotic pathways/ responses

• origin- leukemia (bone marrow or blood)
•           Lymphoma (lymph node)

nonhodkin lymphoma

lymphoid progenitor origin

B lymphocytes origin

genetic alteration, infection, antigen stimulation, immunosurppression

antibiotic

–congenital (Wiskott-Aldrich)

–organ transplant

–AIDS

–increasing age

–ataxia telangiectasia

–xeroderma pigmentosum

• HL: 1 lymphoma. can be cured by rad. 
• NHL: multiple lymphoma. dont know exactly which one

Indolent Disease: slow-growing  but incurable (come back, residual). 85-90% present in Stage III or IV

Intermediate/Aggressive Disease: a little more rapid growing (weeks and months). curable

High-grade/Very Aggressive Disease: rapid growing (hours). curable

6th most common cause of cancer death in United States.

Increasing in incidence and mortality.

Since 1970, the incidence of lymphoma has almost doubled

Lymphadenopathy

Cytopenias: low RBC, WBC, platelet

Systemic symptoms

Hepatosplenomegaly

• B - symptoms (worse prognosis)
• Fever, Night sweats, Weight loss

fluctuate or spontaneously remit, especially in low-grade lymphomas.

more common in high-grade lymphomas

no predictable pattern

• Excisional biopsy is preferred to
• show nodal architecture

–Evaluate Morphology

–Evaluate Nodal Architecture (where the malignant cells are in the node)

• biopsy
• immunogistochemistry
• flow cytometry
• chromosome changes

CBC, chemistries, urinalysis

CT scans of chest, abdomen and pelvis

Positron Emission Tomomgraphy (PET)

Bone marrow biopsy and aspirate

Lumbar puncture

• –AIDS lymphoma
• –T cell lymphoblastic lymphoma
• –High grade lymphoma with positive marrow

it is used to evaluate the burden of the disease. it's curable even at higher rate

Constitutional symptoms

Anatomic obstruction

Organ dysfunction

Painful lymph nodes

Cytopenias

Autoimmune

Immunodeficiency

Most common type of “indolent” lymphoma

Usually widespread at presentation

Often asymptomatic

Not curable (some exceptions)

Associated with BCL-2 gene rearrangement [t(14;18)]

Cell of origin: germinal center B-cell

CD20 antibody --> recruit complement, cell-mediated cytotoxicity, apoptosis

Most common type of aggressive” lymphoma

Usually symptomatic

Extranodal involvement is common

Cell of origin: germinal center B-cell

Treatment should be offered

Curable in ~ 60-75%

Present with a rapidly enlarging symptomatic mass, most usually nodal enlargement in the neck or abdomen.

Systemic "B" symptoms (ie, fever, weight loss, drenching night sweats) are observed in approximately 30 percent of patients

Serum LDH is elevated in over one-half

60 percent of patients will present with advanced stage DLBCL (usually stage III or IV disease) while 40 percent have more localized disease, usually defined as that which can be contained within one irradiation field

Bone marrow is involved in up to 30 percent of cases

Extranodal extramedullary disease occurs in up to 40 percent of cases

Jaw mass

In U.S., about 50% EBV infection.

May present as abdominal mass.

Most rapidly growing human tumor.

Typical chromosome abnormality: c-myc oncogene linked to one of the immunoglobulin genes.

diffuse itching

reed-sternberg cell

• Lymph node enlargement, usually
• cervical or mediastinal.

Systemic “B” symptoms common.

Pel-Ebstein fever.

• –relapsing, high-grade fever that
• can reach 105-106°F, periodicity of 7-10 days. Fever spikes abrupt in onset and
• resolution

Pain on drinking alcohol.